What is coronary heart disease?

Coronary heart disease (CHD) affects the blood vessels that supply blood to your heart. Coronary heart disease is also called 'coronary artery disease'.

Coronary heart disease is the usual cause of heart attacks and angina. It's the leading cause of death in Australia.

What are the symptoms of coronary heart disease?

Coronary heart disease develops slowly. You may not have any symptoms in the early stages of the disease.

For many people, the first symptoms of coronary heart disease are due to:

• angina
• a heart attack

Chest pain is the most common symptom of angina and heart attack. But the symptoms of heart attacks can vary between different people, including between males and females.

What causes coronary heart disease?

The arteries (blood vessels) that supply your heart with blood and oxygen are called your coronary arteries. Coronary heart disease occurs when these arteries become blocked or narrowed.

Blockages of your coronary arteries happen because of a buildup of plaque inside the arteries. Plaque is made up of fat, cholesterol and other materials. Over time, the plaques grow, making the coronary arteries narrower. This process is called 'atherosclerosis'.

When the coronary arteries are very narrow, it can restrict blood flow. You may notice symptoms of angina, such as chest pain or breathlessness when you do activities. That's because not enough blood is getting to your heart muscle.

If part of a plaque breaks off, a blood clot can form in one of your coronary arteries. This can block the blood flow completely. This is what happens when you have a heart attack.

Risk factors for coronary heart disease

There is no one cause of coronary heart disease. But there are risk factors that can increase your chance of developing the condition. Some risk factors for coronary heart disease can be changed, while others can't.

Risk factors related to your lifestyle are:

• smoking
• being overweight or obese
• having an unhealthy diet
• not getting enough exercise or physical activity
• drinking too much alcohol

Other risk factors are:

• your age — your risk is higher as you get older
• being male
• being a female after menopause
• your ethnicity
• your family medical history

Having certain conditions can also increase your risk of CHD. These include:

• high blood pressure
• high cholesterol
• diabetes
• chronic kidney disease
• depression and severe mental illness
• obstructive sleep apnoea

When should I see my doctor?

If you don't have any symptoms, having regular Heart Health Checks helps you to understand your risk of a heart attack or stroke. And you can work with your doctor to lower your risk.

Who should have a Heart Health Check and what does it involve?

All people aged 45 to 79 years should have a Heart Health Check with their doctor.

Aboriginal and/or Torres Strait Islander people should start having Heart Health Checks from the age of 30 years. People with diabetes should start at 35 years.

At your Heart Health Check, a doctor or nurse will check your:

• blood pressure
• blood sugar levels
• cholesterol levels
• family medical history
• lifestyle
• general health
• medicines you are taking

With this information, your doctor can work out your risk of having a heart attack or stroke in the next 5 years. If needed, your doctor or nurse will work with you to create a management plan. This will help you to keep your heart healthy.

How is coronary heart disease diagnosed?

Your doctor will ask about any symptoms you have and examine you. They will also ask about your lifestyle, general health and family history.

Depending on your symptoms and situation, they may recommend tests, such as:

• an electrocardiogram (ECG)
• a chest x-ray
• blood tests
• a coronary angiogram or cardiac catheterisation
• an echocardiogram — ultrasound scan of your heart
• an exercise stress test — which measures your blood pressure and heart activity during exercise

Your doctor may refer you to a cardiologist (heart specialist).

How is coronary heart disease treated?

Coronary heart disease is treated with a combination of lifestyle changes, medicines and sometimes surgery.

If you have coronary heart disease, your doctor will help you build a personalised management plan. This plan will help improve your symptoms and help prevent you from having a heart attack.

Lifestyle changes

Maintaining a healthy lifestyle is very important to help you manage coronary heart disease. Lifestyle measures include:

• quitting smoking and vaping
• eating a healthy, balanced diet
• getting regular physical activity
• maintaining a healthy weight
• reducing how much alcohol you drink
• reducing stress

Cardiac rehabilitation programs can help you make practical changes in your lifestyle. Your doctor may refer you for cardiac rehabilitation.

Medicines

Coronary heart disease is also treated with medicines. These can help reduce your risk factors and treat your symptoms.

These may include treatments that:

• lower your blood pressure
• lower your cholesterol
• prevent blood clots
• treat your angina

Surgical treatments

In some cases, you may need surgery to improve the blood flow to your heart. Surgical treatments can include:

• angioplasty and stent implantation
• bypass surgery (coronary artery bypass graft surgery — CABG)

Angioplasty involves placing a small, inflated balloon in the blocked blood vessel. This clears the way for blood to flow through. After this, an expandable metal tube (stent) is left in place to keep your blood vessel open.

Cardiac bypass surgery aims to improve the blood flow to your heart.

Can coronary heart disease be prevented?

You can help prevent coronary heart disease by reducing your risk factors.

A Heart Health Check with your doctor or nurse will help you to:

• identify your risk factors
• build a plan to manage them

You can work with your doctor to lower your risk of heart disease. Your doctor may:

• recommend lifestyle measures — such as quitting smoking or vaping, eating a healthy diet, getting enough physical activity and limiting your alcohol intake
• refer you to programs or healthcare professionals, such as a dietitian
• prescribe treatment — such as medicines to lower your blood pressure or cholesterol

If you have already had a heart attack, it's even more important that you:

• manage your risk factors
• follow your management plan
• check in frequently with your healthcare team

What are the complications of coronary heart disease?

Coronary heart disease can cause serious complications that can be life threatening. As well as heart attack and angina, coronary heart disease may cause:

• arrhythmias — abnormal heart rhythms
• heart failure — weakening of your heart muscle

Resources and support

The Heart Foundation has information on heart health, coronary heart disease and cardiac rehabilitation programs.

The Heart Foundation also has heart health information in languages other than English.

Information on heart health for Aboriginal and/or Torres Strait Islander people can be found at:

• Heart Health
• Australian Indigenous HealthInfoNet
• National Aboriginal Community Controlled Health Organisation (NACCHO)

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.